scholarly journals Spontaneous cerebrospinal fluid leak from the optic canal

2017 ◽  
Vol 5 ◽  
pp. 2050313X1774828
Author(s):  
Kyle Hannabass ◽  
Jeb M Justice
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Retrospective Chart Review ◽  
Cerebrospinal Fluid Leak ◽  
Optic Nerve Sheath ◽  
Anatomic Site ◽  
Endoscopic Closure ◽  
Nerve Sheath ◽  
Cerebrospinal Fluid Leaks ◽  
Fluid Leak

Objective: To present a case of successful repair of a spontaneous cerebrospinal fluid leak in a previously unreported anatomic site. Methods: Retrospective chart review. Results: A 48-year-old woman developed a spontaneous cerebrospinal fluid leak from the optic nerve sheath and underwent a multilayer endoscopic closure with no damage to the optic nerve. Conclusion: Endoscopic surgeons can successfully repair cerebrospinal fluid leaks from the optic nerve sheath without causing loss of vision.

Sonography of the optic nerve sheath diameter before and after microsurgical closure of a dural CSF fistula in patients with spontaneous intracranial hypotension – a consecutive cohort study

Cephalalgia ◽  
2018 ◽  
Vol 39 (2) ◽  
pp. 306-315 ◽  
Author(s):  
Jens Fichtner ◽  
Christian T Ulrich ◽  
Christian Fung ◽  
Debora Cipriani ◽  
Jan Gralla ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Cerebrospinal Fluid Leak ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Cerebrospinal Fluid Leakage ◽  
Nerve Sheath ◽  
Fluid Leak

Objective Spontaneous intracranial hypotension is caused by spinal cerebrospinal fluid leakage. Patients with orthostatic headaches and cerebrospinal fluid leakage show a decrease in optic nerve sheath diameter upon movement from supine to upright position. We hypothesized that the decrease in optic nerve sheath diameter upon gravitational challenge would cease after closure of the leak. Methods We included 29 patients with spontaneous intracranial hypotension and refractory symptoms admitted from 2013 to 2016. The systematic workup included: Optic nerve sheath diameter sonography, spinal MRI and dynamic myelography with subsequent CT. Microsurgical sealing of the cerebrospinal fluid leak was the aim in all cases. Results Of 29 patients with a proven cerebrospinal fluid leak, one declined surgery. A single patient was lost to follow-up. In 27 cases, the cerebrospinal fluid leak was successfully sealed by microsurgery. The width of the optic nerve sheath diameter in supine position increased from 5.08 ± 0.66 mm before to 5.36 ± 0.53 mm after surgery ( p = 0.03). Comparing the response of the optic nerve sheath diameter to gravitational challenge, there was a significant change from before (−0.36 ± 0.32 mm) to after surgery (0.00 ± 0.19 mm, p < 0.01). In parallel, spontaneous intracranial hypotension-related symptoms resolved in 26, decreased in one and persisted in a single patient despite recovery of gait. Conclusions The sonographic assessment of the optic nerve sheath diameter with gravitational challenge can distinguish open from closed spinal cerebrospinal fluid fistulas in spontaneous intracranial hypotension patients. A response to the gravitational challenge, that is, no more collapse of the optic nerve sheath while standing up, can be seen after successful treatment and correlates with the resolution of clinical symptoms. Sonography of the optic nerve sheath diameter may be utilized for non-invasive follow-up in spontaneous intracranial hypotension.

Cerebrospinal Fluid-Related Complications With Autologous Duraplasty and Arachnoid Sparing in Type I Chiari Malformation

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS156-ONS161 ◽  
Author(s):  
Caitlin E. Hoffman ◽  
Mark M. Souweidane
Keyword(s):  
Cerebrospinal Fluid ◽  
Retrospective Chart Review ◽  
Cerebrospinal Fluid Leak ◽  
Morbidity Rate ◽  
Type I ◽  
Symptomatic Disease ◽  
Aggressive Surgical Approach ◽  
The Mean ◽  
Postoperative Hydrocephalus ◽  
Fluid Leak

Abstract Objective: Although there is a current consensus that Type I Chiari malformations (CM-I) should be treated only in the setting of symptomatic disease, significant controversy surrounds the most appropriate surgical procedure. Recent enthusiasm for osseous decompression without duraplasty is supported by the purportedly lower morbidity of this approach. Precise rates of morbidity with duraplasty, however, have not been reported. This study is intended to assess the cerebrospinal fluid-related morbidity associated with a patient population treated uniformly with autologous duraplasty for symptomatic CM-I. Methods: A review of one surgeon's practice (MMS) from 1997 to 2007 identified patients treated for symptomatic CM-I with osseous decompression and autologous duraplasty. A retrospective chart review was then performed for these patients with an emphasis on cerebrospinal fluid-related complications. Results: Forty patients were treated for CM-I with decompression and autologous duraplasty. Twenty-four patients presented with a preoperative syrinx. The mean age was 13.3 years, and the median age was 12.9 years (range, 3.3–45.8 yr). The mean follow-up period was 11.4 months (range, 1–101 mo). There was no mortality associated with the procedure. Clinical response was observed in 91.8% of patients, with 70.2% experiencing complete symptomatic resolution and 21.6% experiencing partial improvement. Two patients (5.4%) had persistent symptomatic syringomyelia requiring syringosubarachnoid shunting. There was an overall morbidity rate of 2.5% due to one pseudomeningocele treated with a single percutaneous tap. There were no incidences of cerebrospinal fluid leak, meningitis, or postoperative hydrocephalus. Conclusion: The cerebrospinal fluid-related morbidity associated with autologous duraplasty for CM-I in a uniformly treated population is negligible. These results challenge the current rationale for a less aggressive surgical approach to CM-I.

“Gasket-seal” Watertight Closure in Minimal-access Endoscopic Cranial Base Surgery

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS342-ONS343 ◽  
Author(s):  
Lewis Z. Leng ◽  
Seth Brown ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
Cranial Base ◽  
Minimal Access ◽  
Anterior Cranial Base ◽  
Tissue Sealant ◽  
Cerebrospinal Fluid Leaks ◽  
Cranial Base Surgery ◽  
Watertight Closure ◽  
Fluid Leak

Abstract Objective: Transnasal endoscopic cranial base surgery is a novel minimal-access method for reaching the midline cranial base. Postoperative cerebrospinal fluid leak remains a persistent challenge. A new method for watertight closure of the anterior cranial base is presented. Methods: To achieve watertight closure of the anterior cranial base, autologous fascia lata was used to create a “gasket seal” around a bone buttress, followed by application of a tissue sealant such as DuraSeal (Confluent Surgical, Inc., Waltham, MA). The gasket-seal closure was used to seal the anterior cranial base in a series of 10 patients with intradural surgery for suprasellar craniopharyngiomas (n = 5), planum meningiomas (n = 3), clival chordoma (n = 1), and recurrent iatrogenic cerebrospinal fluid leak (n = 1). Lumbar drains were placed intraoperatively in five patients and remained in place for 3 days postoperatively. Results: After a mean follow-up period of 12 months, there were no cerebrospinal fluid leaks. Conclusion: The gasket-seal closure is an effective method for achieving watertight closure of the anterior cranial base after endoscopic intradural surgery.

Immunisations and antibiotics in patients with anterior skull base cerebrospinal fluid leaks

2014 ◽  
Vol 128 (7) ◽  
pp. 626-629 ◽  
Author(s):  
J Rimmer ◽  
C Belk ◽  
V J Lund ◽  
A Swift ◽  
P White
Keyword(s):  
Cerebrospinal Fluid ◽  
Streptococcus Pneumoniae ◽  
Antibiotic Prophylaxis ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Prophylactic Antibiotics ◽  
Anterior Skull Base ◽  
Web Based ◽  
Cerebrospinal Fluid Leaks ◽  
Fluid Leak

AbstractObjective:There are no UK guidelines for the use of antibiotics and/or immunisations in patients with an active anterior skull base cerebrospinal fluid leak. This study aimed to define current UK practice in this area and inform appropriate guidelines for ENT surgeons.Method:A web-based survey of all members of the British Rhinological Society was carried out and the literature in this area was reviewed.Results:Of those who responded to the survey, 14 per cent routinely give prophylactic antibiotics to patients with cerebrospinal fluid leaks, and 34.9 per cent recommend immunisation against at least one organism, most commonly Streptococcus pneumoniae (86.7 per cent).Conclusion:There is no evidence to support the use of antibiotic prophylaxis in patients with a cerebrospinal fluid leak. We propose that all such patients are advised to seek immunisation against pneumococcus, meningococcus and haemophilus.

Endoscopic modified Lothrop procedure for repair of lateral frontal sinus cerebrospinal fluid leak

2008 ◽  
Vol 123 (1) ◽  
pp. 145-147 ◽  
Author(s):  
J K Anverali ◽  
A A Hassaan ◽  
H A Saleh
Keyword(s):  
Cerebrospinal Fluid ◽  
Frontal Sinus ◽  
World Literature ◽  
Cerebrospinal Fluid Leak ◽  
Lumbar Drain ◽  
Alternative Approach ◽  
Cerebrospinal Fluid Leaks ◽  
Fluid Leak

AbstractObjective:To describe a previously unreported case of repair of a lateral frontal sinus cerebrospinal fluid leak, using the endoscopic modified Lothrop procedure.Method:Case report of new technique, with reference to the world literature.Results:An effective endoscopic, transnasal repair of a lateral frontal sinus cerebrospinal fluid leak was achieved in a 60-year-old man. The defect was closed with fat, fascia lata and free mucosal grafts. The left nasal cavity was packed and a lumbar drain left in situ post-operatively. The drain and packs were removed one week later and the patient discharged with no complications, and no recurrence at 12 months' follow up.Conclusion:Such cerebrospinal fluid leaks have traditionally been repaired using an external approach with osteoplastic flaps and obliteration of the sinus. We highlight the endoscopic modified Lothrop technique as an effective alternative approach to repair of cerebrospinal fluid leaks in poorly accessible areas of the frontal sinus.

Cerebrospinal fluid and optic nerve sheath compartment syndrome: A common pathophysiological mechanism in five different cases?

2019 ◽  
Vol 48 (2) ◽  
pp. 212-219 ◽  
Author(s):  
Jie Hao ◽  
Achmed Pircher ◽  
Neil R. Miller ◽  
Jiemei Hsieh ◽  
Luca Remonda ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Compartment Syndrome ◽  
Optic Nerve Sheath ◽  
Pathophysiological Mechanism ◽  
Nerve Sheath
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